| NPI | 1669029609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-30858) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: AZ 30858) |
| Enumeration Date | 2019-08-23 |
| Last Update Date | 2024-04-15 |